Posted by paulb on March 3, 2002, at 18:30:01
In reply to Need advice:combo works differently 2nd time aroun, posted by Anna Laura on March 3, 2002, at 15:24:50
Hi Anna Laura,
I know you have been here for a while and I feel I know a little bit about you. You live in Italy and you have severe anhedonia. Im sorry to hear your medicine isnt helping. Your post was very medication focused. Has you ever tried augmenting the medication with psychotherapy.In regard to medication, I cant see the rationale for using Effexor and Reboxetine since Effexor will enhance norepinephrine. Your right though, anhedonia would be a condition associated more with norepinephrine and/or dopamine and therefore Effexor may not be a good choice because it increases serotonin as well. Reboxetine alone is a possibility however it hasnt made much of a bang, being as it is the first SNRI and from what I can gather over here in the UK not many are on it. Its metabolised by the Cytochrome P450 system the same as Paroxetine which is basically Reboxetine's twin, only it enhances Serotonin-potently, selectively and cleanly. The difference is that Paroxetine is prescribed in 20-60mg tabs/liquid formulation and Reboxetine in 4mg-12mg?. Studies have shown over and over again that at 10mg Paroxetine doesnt do much. Perhaps this is true of Reboxetine. Its a shame but all is not lost, far from it......
I can forsee three possibilities for you:
Wellbutrin-Blockade of norepinephrine re-uptake
Desipramine-Blockade of norepinephrine re-uptake
Maprotiline-Even more so than Desipramine, a re-uptaketer of norepinephrineAugment with T3. Much evidence is available for this augmentation stategy and I have reason to believe that it is a better augmentor with the norepinephrine antidepressants than others.
If you got one of the TCA's I mentioned and T3 and still had problems you could consider an anticonvulsant such as Lamotrigine.
This is just a viewpoint and not recommendation, rather something I would look into if I was you.
In the past you mentioned L-Dopa. You are obviously aware of the importance of the catecholamines role in drive and energy. As I suggested back then why not try L-Tyrosine. Did you? Did you have any luck?
PaulB
poster:paulb
thread:96197
URL: http://www.dr-bob.org/babble/20020301/msgs/96220.html